| Entity Name: | PROVIDENCE COMMUNITY HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Dec 2020 (4 years ago) |
| Document Number: | L20000378949 |
| FEI/EIN Number | 85-4350502 |
| Address: | 2150 S CONGRESS AVE, PALM SPRINGS, FL, 33406, US |
| Mail Address: | 2150 S CONGRESS AVE, PALM SPRINGS, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093471815 | 2021-11-16 | 2021-11-16 | 2150 S CONGRESS AVE, PALM SPRINGS, FL, 334067604, US | 2150 S CONGRESS AVE, PALM SPRINGS, FL, 334067604, US | |||||||||||||
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| Phone | +1 561-619-3891 |
Authorized person
| Name | SAUL ERNEST |
| Role | MANAGING MEMBER |
| Phone | 5616193891 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ERNEST SAUL | Agent | 16225 SW 19TH ST, MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| ERNEST SAUL | Manager | 16225 SW 19TH STREET, MIRAMAR, FL, 33027 |
| DORVAL JULINA T | Manager | 5932 NE 2 AVE, MIAMI, FL, 33137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-10-13 | 2150 S CONGRESS AVE, PALM SPRINGS, FL 33406 | No data |
| CHANGE OF MAILING ADDRESS | 2021-10-13 | 2150 S CONGRESS AVE, PALM SPRINGS, FL 33406 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-10-13 | 16225 SW 19TH ST, MIRAMAR, FL 33027 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-07 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-03-04 |
| AMENDED ANNUAL REPORT | 2021-10-13 |
| AMENDED ANNUAL REPORT | 2021-08-19 |
| AMENDED ANNUAL REPORT | 2021-07-26 |
| ANNUAL REPORT | 2021-04-30 |
| Florida Limited Liability | 2020-12-03 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
